Age-appropriate targets for self-care education for children with diabetes

1. Age-appropriate targets for self-care education for children with diabetes

2. The newly-diagnosed child • Admission to hospital: • duration normally 3–5 days, depending on the child’s condition and the family situation • treatment for ketoacidosis • starting subcutaneous insulin-treatment and diabetes education • The education: • co-ordinated by the diabetes nurse and carried out by members of the multi-disciplinary diabetes team

3. Starting diabetes education 1 • First conversation with the family: • try to establish good contact and create confidence • talk about the experiences before and during the stay in hospital • try to remove any sense of guilt • promise: • “it can be done” • 24-hour hot-line service • good life with minimum restrictions

4. Starting diabetes education 2 • Necessary knowledge before discharge from hospital: • administration and injection of insulin • testing blood glucose • knowing acceptable blood glucose values • symptoms and treatment of hypoglycaemia • simple principles for food administration • talk to the social worker about reimbursement of: • diabetes devices • sick-leave for one parent for a short period • Instruct about daily contact by telephone to discuss adjusting insulin dose

5. Out-patient diabetes education 1 • Starts 1–2 weeks after discharge from hospital • Lasts about 6 months • Primarily carried out by the diabetes nurse and the dietician • Includes training/visits to childcare institutions, schools etc. • Home visits also possible

6. Out-patient diabetes education 2 • Who is educated? • patient and parents • brothers, sisters and friends • other members of the family • personnel in childcare institutions/school • other 'baby-sitters'

7. Out-patient diabetes education 3 • Qualifications of the educator: • great practical and theoretical knowledge • open and good listener • able to treat each family individually according to the family’s abilities

8. Out-patient diabetes education 4 • Important to find the balance between optimum and sufficient knowledge

9. Special problems 1 • Age: • infants • young people/adolescents • Culture/language/religion: • immigrants/refugees • Social problems

10. Special problems 2 • Aim of education: • to secure good diabetes regulation without complications but at the same time create possibility of a good childhood/youth – 'development without tripping' • Small children: • achieve normal physical, psychological and intellectual 'milestones' • Young people: • knowledge and experience + family trust and support = better accept and compliance

11. Other offers of education 1 • Groups: • social activities for children arranged by a local section of the national diabetes association • group for parents with very young children run by psychologist and social worker • group arrangements for children of the same age together with their parents – combination of out-patient clinic and education. • special projects for small group of young people in puberty

12. Other offers of education 2 • Groups: • education on different topics for young people aged 12–15 and 16–18 years – each twice a year • This year’s topics: • pizza, hamburgers, alcohol and parties • physical activity • good regulation/insulin management • sickness/ketoacidosis

13. Written material 1 • Coping with Diabetes: • large numbers of papers on different topics and levels • intended as short and precise guidelines in practical diabetes management • always handed out in connection with oral instruction

14. Written material 2 • Age-appropriate education and evaluation material: • created by teachers, psychologists and diabetes nurses • describes practical and theoretical knowledge of diabetes for children and young people aged 16–17 years • goals are adjusted and adapted to the educational level, abilities and psychological development of the child

15. Written material 3 • Age-appropriate education and evaluation material includes: • age-appropriate goals for members of the team • guidelines for the diabetes patient and family • evaluation of material/methods

16. Transfer to the diabetes out-patient clinic • First visit maximum 6 months after diagnosis • Visits every 2–3 months until aged 18 years • Meets: • doctor/paediatrician • diabetes nurse • dietician • laboratory technician • chiropodist • social worker (if needed) • psychologist (if needed) • If needed, re-education should be offered (e.g. as the child grows older or metabolic control is poor)

17. Age-appropriate goals:general 1 • 6–7 years: • parents are responsible for the daily diabetes care • the child could be encouraged to help • 8–9 years: • child takes over a larger part of the practical responsibility for diabetes care • the parents, however, still have the main responsibility • 10–11 years: • child needs only limited theoretical background, but should be able to take practical responsibility for diabetes care • the parents should assist in dosing insulin

18. Age-appropriate goals: general 2 • 12–13 years: • the child takes practical care of the diabetes and begins to acquire the theoretical background • 14–15 years: • the young person takes care of the diabetes and has now acquired the requisite theoretical background • 16–17 years: • preparations are made for adult life, as the diabetes becomes a matter between the young person and the diabetes team • he/she is motivated to obtain further knowledge and experience, practical as well as theoretical

19. Age-appropriate goals:detail • Knowledge of diabetes • 'Rules of the game': • food, insulin and exercise. • Blood glucose: • testing • hypo- and hyperglycaemia • Special precautions: • sickness • eating/sleeping away from home • hyperglycaemia • Complications of diabetes